Effect of propranolol and spironolactone on body weight, extracellular fluid and intracellular fluid sodium, urinary sodium and total urine output per 24 hours in chronic liver diseases

Ascites is one of the most common complications of chronic liver diseases and usually requires frequent and often prolonged hospitalization. Increased renal tubular sodiumreabsorption is the predominant mechanism. Activation of renin - angiotensin - aldosterone system and of the sympathetic nervous system play important roles in this process. Aldosterone would help reabsorption of sodium and water from the distal and collecting tubules. Spironolactone is a known drug that antagonizes the effect of aldosterone in these segments. Activation of the sympathetic nervous system results in reduction of the renal blood flow, glomerular filtration rate, increase in sodium and water reabsorption from the different nephron segments and increase in renal synthesis and release of renin. Propranolol is a non selective beta adrenoreceptor blocking drug that will block the effects of overactive sympathetic nervous system. Again, propranolol will inhibit activation of renin - angiotensin - aldosterone system, added to its known portal hypotensive effect. In this work, the effect of combined therapy of spironolactone and propranolol for 14 days on body weight, daily urine output, urinary sodium was studied on 10 non azotaemic patients with chronic liver disease and ascites. Results of this work showed a highly significant increase in urinary sodium and a significant increase in daily urine output after therapy. The body weight, intracellular sodium and extracellular sodium showed an insignificant change after therapy with spironolactone and propranolol in combination. According to the results obtained in this work, we recommend the usage of spironolactone and propranolol combination with or without other lines of therapy in treating non azotaemic patients with chronic liver disease and ascites